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Feature: Using operational data to support the redesign of clinical pathways across an ICS

For the latest in the HTN feature series which focuses on digital transformation for integrated care systems (ICS), HTN spoke with David Hancock, Healthcare Executive Advisor at InterSystems.

In our virtual chat we discussed the role of operational data, the need for data liquidity, and how to approach system-wide pathway design and workflow.

David sets the scene of the conversation: many integrated care systems are in place, functioning even in shadow form, and are focusing on delivering care to their population. However, they all need to be in place – and up and running – by April 2022. However, in reality, they need to all exist and be functioning well before that date; in order to plan, organise and commission themselves to deliver services.

ICSs are being created because individual organisations working on their own cannot solve the issues in health and care today. Individual leaders have to think bigger than themselves and their own organisations, if they are to solve the system problems.

Many providers have examples of when solving issues in their own organisation has had an adverse impact on another care provider. So, problem solving today has to be done from a wider perspective, rather than by individual organisations.

What are the current problems facing ICSs re: digital transformation?

Many ICSs have shared care records in place, and that has been the focus – to support their work. Yes, there are still a number who don’t have these in place, but the challenge is these systems are not the primary or core system used by healthcare professionals, all hours of the day. These Shared Care Records manage demographic and clinical data, but they don’t manage any of the operational data, that is the data that helps systems prioritise and plan their work.

It’s widely agreed that shared care records support workers at the point of care, help clinicians get it right first time, and help improve the patient experience. These solutions are central to the functioning of an ICS but don’t solve some of the key issues.

ICSs need to think about what digital infrastructure they will need to have in place to support them to solve a much wider set of issues. For example, an ICS responding as a whole to the NHS planning guidance in March this year to focus on elective surgery. A shared care record won’t help with operational aspects such as understanding what the current waiting list looks like, who is the most clinically important, and how to schedule the patient to proceed with their care.

What now needs to be done is to look at this from a regional perspective; a patient might be on a waiting list at one trust, but could be moved to another if it means they are treated more appropriately based on their priority across the whole ICS. After all, it’s the system that will be measured, and the system that receives the money from the Elective Recovery Fund. 

How can an ICS approach this issue?

It will be key for an ICS to understand its backlog and redesign its ways of working to decrease the number of people on waiting lists.  It needs operational data flowing around the ICS to help it manage its operation as a whole.

The ICS will additionally want to use the opportunity to change clinical pathways and clinical workflow, for what is done where. Practically, an ICS will need to focus on what information is needed in the clinical workflow, as a way to support these new pathways. However, at the same time as ICSs increase their digital maturity, clinicians will be in their EPRs more and more and will want to stay in them, and expect data from other systems to come to them. Rather than viewing the data in a separate portal, it needs to be right there in front of clinical teams in the core system.. This requires direct ingestion of data from other systems – you need to take data and put it into primary systems.

This is increasingly important. While managing data at rest in a Shared Care Record is important and hugely valuable, an ICS needs to manage data in flight, so data liquidity here is vital. To effectively manage the backlog, it requires operational data around the ICS for planning, and this can then lead on to moving data into EPRs for patient management and scheduling.

So, it’s operational data that’s key to support decision making in who is seen when, and how. That’s the main problem – integrating data and clinical workflow is key to this.

How is InterSystems helping ICSs to tackle these issues?

We’re having lots of conversations with systems across the country at the moment, discussing shared care records and managing data in flight – essentially regional integration solutions.

Integration engines have been around for some time. But now it’s a move to being across an ICS as a data layer, and that will be key. It’s not new, this has been done before. It can work with existing integration solutions in trusts and operating across an ICS gives you potential to benefit from economies of scale in both deployment and maintenance.

In Leeds and the Yorkshire and Humberside region, they have been using our integration technology – Health Connect – to create a regional platform for radiology. In Scotland, they have been working in this way for some time and connecting across multiple health boards.

The key is to improve liquidity of data. And that’s what we think ICS leaders should be thinking about at a system level, as it then provides a capability to solve many problems and will be an important architectural cornerstone for your system.


For more content on technologies supporting ICSs, visit HTN’s dedicated new channel.